Healthcare Provider Details

I. General information

NPI: 1326397233
Provider Name (Legal Business Name): HEATHER LAUREN BURR MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 MELALEUCA LANE
GREENACRES FL
33463
US

IV. Provider business mailing address

1240 LAKE BREEZE DRIVE
WELLINGTON FL
33414
US

V. Phone/Fax

Practice location:
  • Phone: 561-649-0877
  • Fax: 561-649-8408
Mailing address:
  • Phone: 954-235-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT1054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: